Sciatica sufferers: Is it time for surgery?

If you have sciatica, it can feel like there’s no escape from the excruciating pain. It may feel like a bad leg cramp or a jolt of electricity running down the back of your leg. Or, you may have a burning sensation or “pins and needles” feeling that just won’t seem to go away. Whether you sit or stand, take medication, stretch or get acupuncture, relief is hard to come by and fleeting.

While non-invasive, non-surgical techniques are the first line of treatment that can help sciatica sufferers, there’s new evidence that it may be better to pursue a surgical solution sooner rather than later. Your doctor can provide the necessary information to help you make an informed decision about your options.

“It’s never easy to decide if surgery is the right course of treatment for your sciatica,” said Geisinger neurosurgeon Stanley Pugsley, MD, FACS. “However, there is a growing body of evidence that surgery should be considered relatively early, since it is relatively low-risk and can provide pain relief sooner than other treatments.”
Early surgery provides faster relief

The most common cause of sciatica is a herniated or slipped spinal disc. A spinal disk is a structure that sits between the vertebrae of your spine and acts like a shock absorber. It’s shaped like a donut, with a tough exterior and a soft “jelly-like” interior.

“As you age, spinal discs become less flexible and can rupture, causing some of the soft interior to push through,” said Dr. Pugsley. “This can irritate the surrounding nerves and lead to conditions such as sciatica.”

A new study indicates that it may be better to pursue surgery for sciatica earlier than once thought. Researchers took patients with sciatica caused by herniated discs and split them into two groups. The first group was assigned to have surgery early, within two weeks from the beginning of the study. The second group received conservative, nonsurgical treatment with the option to have surgery at a later date.

The results showed that among the nonsurgical group, nearly 40 percent of patients did not experience significant pain relief from conservative treatments and eventually decided to have surgery. In comparison, the group that had early surgery experienced pain relief about 16 weeks sooner than the nonsurgical group. Surgery was the fastest way for these patients to get relief from their sciatica pain.

Is sciatica surgery right for you?

Deciding whether or not to have surgery for sciatica pain relief is a personal decision. Your doctor can provide you with the information you need to make that decision. If you do decide to try a more conservative, nonsurgical treatment first, it will include:

Medication for pain relief, such as aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve)

Like the participants in the study, you can always decide to have surgery later if you start with a conservative, nonsurgical treatment first.

“An experienced surgeon can walk you through all of the options available for treating your sciatica,” said Dr. Pugsley. “While the pain can seem unrelenting now, together with your doctor you will identify a treatment plan that can bring you relief.”